MEDICARE: AUTUMN SHEESE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	71002091A	IN
2	363LP2300X	Primary Care Nurse Practitioner	28145312A	IN
3	363LP2300X	Primary Care Nurse Practitioner	71002091A	IN

General Provider Information

NPI Number	:	1649459330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN SHEESE NP

Provider Business Mailing Address
First Line	:	1214 E NATIONAL AVE STE 100
Second Line	:
City	:	BRAZIL
State	:	IN
Zip	:	47834-2700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 E NATIONAL AVE STE 100
Second Line	:
City	:	BRAZIL
State	:	IN
Zip	:	47834-2700
Country	:	US
Telephone Number	:	812-442-2820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	05/04/2023

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Directions to “ AUTUMN SHEESE NP” Practice Location

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